Midodrine: Current Status in the Treatment of Hypotension
Midodrine: Current Status in the Treatment of Hypotension
Midodrine is a sympathomimetic agent used in the treatment of hypotension resulting from various aetiologies. Debate around the use of midodrine recently increased after it was threatened with a licence withdrawal in the USA. The reason cited was a failure of the manufacturing drug companies to provide previously agreed post-market studies. Conversely, midodrine has never received a licence from the UK regulatory authorities.
We provide a review of its current status and a brief description of our own experience with midodrine over the last 11 years.
Epidemiological studies suggest that at least 40% of the population will experience at least one episode of syncope in their lifetime. The list of potential therapies available to treat hypotension and reduce the likelihood of syncope is extensive (Table 1).
Midodrine is a potent α1 adrenergic agonist that has found widespread use in the treatment of low blood pressure and neurocardiogenic syncope. The active metabolite of midodrine, desglymidodrine, exerts vasopressor actions through activation of alpha-adrenergic receptors of the arteriolar and venous vasculature. Its effects are largely to raise both supine and, more particularly, standing blood pressure through a vasoconstrictor effect to increase peripheral vascular resistance. Although not widely used, midodrine currently ranks ninth in the Medicines and Healthcare products Regulatory Agency (MHRA) list of the top 10 unlicensed medicines imported into the UK in 2010.
Abstract and Introduction
Abstract
Midodrine is a sympathomimetic agent used in the treatment of hypotension resulting from various aetiologies. Debate around the use of midodrine recently increased after it was threatened with a licence withdrawal in the USA. The reason cited was a failure of the manufacturing drug companies to provide previously agreed post-market studies. Conversely, midodrine has never received a licence from the UK regulatory authorities.
We provide a review of its current status and a brief description of our own experience with midodrine over the last 11 years.
Introduction
Epidemiological studies suggest that at least 40% of the population will experience at least one episode of syncope in their lifetime. The list of potential therapies available to treat hypotension and reduce the likelihood of syncope is extensive (Table 1).
Midodrine is a potent α1 adrenergic agonist that has found widespread use in the treatment of low blood pressure and neurocardiogenic syncope. The active metabolite of midodrine, desglymidodrine, exerts vasopressor actions through activation of alpha-adrenergic receptors of the arteriolar and venous vasculature. Its effects are largely to raise both supine and, more particularly, standing blood pressure through a vasoconstrictor effect to increase peripheral vascular resistance. Although not widely used, midodrine currently ranks ninth in the Medicines and Healthcare products Regulatory Agency (MHRA) list of the top 10 unlicensed medicines imported into the UK in 2010.
Source...